Bradley Elliott Borello, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2009016924 Issued in MO

Practice address

12392 Olive Blvd
Creve Coeur, MO 63141-6443

Phone

(314) 878-8770

Fax

(314) 878-5971

NPI assigned

Jul 22, 2009

Last updated

Nov 10, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midwest Eye Associates, Inc.Group PAC ID 3870651508, 9 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bradley.borello@direct.revolutionehr.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midwest Eye Associates, Inc.

  • Optometrist
  • Saint Charles, MO
  • NPI 1215159504
  Medicare reassignment Care Compare group NPD
• Palombi Vision Center PC

  • Primary Care Clinic/Center
  • Wentzville, MO
  • NPI 1528378437
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1248220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636502400000",
    "number": "1225268451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1384 S 5TH ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012444",
            "telephone_number": "636-946-9242",
            "fax_number": "636-946-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12392 OLIVE BLVD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416443",
            "telephone_number": "314-878-8770",
            "fax_number": "314-878-5971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1155 Wentzville Pkwy Ste 119",
            "address_purpose": "LOCATION",
            "city": "Wentzville",
            "state": "MO",
            "postal_code": "633853476",
            "country_code": "US",
            "telephone_number": "636-639-9422",
            "fax_number": "636-639-6713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 Queens Ct Ste G",
            "address_purpose": "LOCATION",
            "city": "Saint Peters",
            "state": "MO",
            "postal_code": "633767375",
            "country_code": "US",
            "telephone_number": "636-441-8010",
            "fax_number": "636-441-5128",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1384 S 5th St",
            "address_purpose": "LOCATION",
            "city": "Saint Charles",
            "state": "MO",
            "postal_code": "633012444",
            "country_code": "US",
            "telephone_number": "636-946-9242",
            "fax_number": "636-946-4903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORELLO",
        "first_name": "BRADLEY",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-22",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2009016924",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225268451",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacqueline Diane Bogard, DC
• Young Ho Bok, DC
• David Gerard Boland, M.ED., L.P.C.
• Jaclyn Bolzenius, M. A.
• Kaitlyn Borden, OTR/L
• Abby Christine Boron, SLP
• Ramona Georgeta Bosma, D.M.D.
• Brian Douglass Bourbon, CERTIFIED PEDORTHIST
• Tonya K Bourn, O.D.
• Loren Nicole Boushey, COTA/L

• Optometrist in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.